Tip: Review critical care criteria for the ED

APCs Insider, October 16, 2015

Coders may report critical care provided in the ED. Critical care is defined as the direct delivery of medical care by a physician or provider to a critically ill or injured patient.

Typically, in such a case, one or more vital organs or organ systems are impaired, and the patient's condition has a high probability of immediate deterioration. In addition, if critical services are not immediately rendered, the patient faces a high probability of death.

Delivering critical care in a moment of crisis or upon being called to the patient's bedside emergently is not the only criterion for providing critical care services.

While not necessarily emergent, treatment and management of a patient's condition under threat of imminent deterioration also meets the requirement. In such a case, failure to initiate interventions on an urgent basis would likely result in sudden, clinically significant, or life-threatening deterioration in the patient's condition.

This tip is adapted from “E/M reporting remains a challenge in the ED" in the October issue of Briefings on APCs.

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